Homografts for mitral valve replacement in florid endocarditis--an alternative to prosthetic replacement

Abstract

Homografts for valve replacement are indicated in acute valve endocarditis. It is assumed that they possess anti-infective properties. Homografts are an established indication in aortic valve replacement. We present our early results with homografts for mitral valve replacement in acute endocarditis. Between July 1996 and March 1998 we used cryopreserved homografts for mitral valve replacement in seven patients. In three cases (age 24, 42, and 34 years) the indication was an acute endocarditis with subsequent severe mitral valve insufficiency. The size of the required homograft was measured preoperatively using transesophageal echocardiography. For implantation the technique described by A. Carpentier was used; for stabilization of the mitral anulus a valvular ring (Physio) was implanted. Follow-up was done every six months including clinical and echocardiographical examinations. After the first postoperative year an Ultrafast-CT was done in addition. One patient had complete mitral valve replacement, in the other two cases the diseased parts of the valve were completely excised and the valve was repaired using a partial homograft. There were no perioperative deaths. In the follow-ups, up to 24 months of uneventful homograft function was documented by echocardiography; no insufficiency > degree I was seen on color Doppler echocardiography. At the last follow-up (mean follow-up 16 months, range 12 to 24 months) the average mitral valve orifice was 2.5 +/- 0.5 cm2, the mean pressure gradient 2.8 +/- 0.8 mm Hg. In Ultrafast-CT no morphological abnormalities of the mitral valves and no dilatation of the left ventricle were seen. There were no signs of a recurrence of the endocarditis in any patient during the follow-up period. Homografts for mitral valve replacement are an interesting alternative to prosthetic valve replacement, especially in younger patients. In cases with acute endocarditis, in which mechanical prosthesis should not be used, a reconstruction or repair of the mitral valve with preservation of the ventricular geometry is possible even if large parts of the mitral valve are infected.